Pain in left foot when putting load on forefoot

tsdh

Barefooters
Feb 25, 2014
21
12
3
43
Vallendar, Germany
Hi docs,

yesterday I've run a trail half-marathon in my huarache sandals which I always do on rocky, gravely runs. As always, I run just for the fun of doing it and in a moderate speed. I'm also used to running longer distances than HM, so this wasn't an exceptionally hard exercise for me.

At kilometer 5 or so, I almost twisted my left ankle when stepping on a loose rock that decided to roll away. But I noticed it early enough to deal with it. But maybe at kilometer 8 I started to feel a pain in my left foot while landing on my forefoot and then again when popping off to the next step. After some more kilometers, the pain got better so that I was able to finish.

Today, when getting out of bed, I almost couldn't step on my left foot. So I went to the hospital where they x-rayed my left ankle. The pictures don't show anything, so the bones seem to be ok. I had the presumption that maybe a cartilage splinter was in the joint, but that doesn't seem to be the case. The doctor moved my ankle manually and couldn't diagnose any instability, limitation in movement or cracks when doing so.

When keeping my ankle straight, I can walk on my heel without much hassles. The pain is only there when putting load on my forefoot. Unfortunately, it's not easy to localize where the pain is exactly. Yesterday while still running, I had the impression it's somewhere in the left part of the left midfoot. Today, when I put load on my left forefoot, the pain is somehow distributed from left to right midfoot and possibly ankle.

If the pain don't stop anytime soon, I'm advised to do a MRT scan to see if there's something wrong with some soft tissue/ligaments. I'm gonna do that ASAP but I'm still seeking for advice since I have the impression that most doctors I'm aware of are not too experienced when it comes to running injuries ("when it hurts while running, don't run") or seek any solution in orthotics ("Oh, you overpronate!"), so it wouldn't be too bad if the problem could be narrowed a bit to some likely causes.

Thanks a lot for any advice!
Tassilo
 
It probably is soft tissue injury. It sounds like you did twist your ankle a bit, just not enough to cause immediate pain, and then aggravated it while finishing the run. It will likely heal on its own, but could take some time, especially if you do things to aggravate it. I don't know if no running is the answer, it could be for a few days, but certainly light running on stable surfaces (not trails) would be better for a while. Your typical RICE approach wouldn't be a bad idea, and even if you don't rest completely, take it easier. Going 100% barefooted throughout the day and walking gently, with smaller strides would be good. If you feel pain when you move, shorten and lighten your stride and see if that helps. You want to protect the area until it does have a chance to heal. An MRI could spot the problem but won't do a thing to fix it and likely won't change how to fix it, either. Medicine has become so technologically driven that we can spend lots of money to tell you how to fix an easy, yet slow healing, problem.
 
By the way, I have a long history of twisting my right ankle with a torn outer ligament twice. That's what drove me to barefoot running in the first place. Whenever I twisted my ankle, the result was pain with swelling.

This time, however, the difference is that it seems nothing is swollen at all (and it's my left foot where I've never had problems with ligaments).
 
So it has been two weeks now since the pain started on that HM. It started to get better day after day, and after about one week, I could walk again without problems. But since then, I can hardly measure any improvement. Still, putting load on my forefoot causes pain so running is still impossible. But at least, now I can localize the pain a bit better. Attached are two pics of my foot where I've put a circle around the areas that hurt when standing on the ball of the left foot. Especially the pain in the region I've drawn on the sole of the foot feels like a strong tension going from the lateral edge of the left midfoot to the inner crosswise arch.

Is there any way to exclude things that would require a therapy other than RICE, e.g., a stress fracture?
 

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While this can be a stress fracture (a bone scan would help rule that out), another possibility is of shortening and tightening of the medial fascia of the leg, which can lock up the ankle mortise, and strain those joints. Unfortunately, most of us think of where it hurts, rather than why. A good sports chiropractor who is well versed in myofascial release and who has studied myers work may be helpful in managing this, since they will be able to adjust the ankle.

If the ankle mortise, calcaneus or affiliated joints dont move properly, the joints in front (MP joints and navicular joint which is the area you photographed) will strain as the joints in back of it do not move properly. I have seen this in many types of runners and it can also cause lower back and knee pain as well since it causes hyper and hypomobility throughout the lower fascio kinetic chain.

If you decided to allow this to heal for 6 weeks (typically needed for a fracture) and the pain returns, what I am suggesting is quite likely. This goes along with that feeling of strong tension.

A sports chiropractor is most likely to be helpful with your situation right now.
 
Hi Backfixer,

thanks for the hint. I'm not sure how likely that is as it sounds more like something that develops over time whereas my issue started within minutes during a run (with a slight ankle twist some K before). But I think I'll consult some sports doctor here in my region who is also a chiropractor. Well, getting an appointment might take a while so probably it'll heal by itself until then but if it comes back, I'll keep you in mind. ;-)

Bye,
Tassilo